ResMed10 EPR question

[Joe Bezz]

I have a ResMed10 and love it! After months of tweeting I am very happy with the machine and the results! My question is with EPR! I had the EPR off and it was suggested from someone in the group that I try using it since my Flow Limit seemed high! Even though my flow limit was close to 0.20 my AHI's were constantly under 1.0 I took the suggestion and went from off to 1 with little change and then to 2. 2 brought my flow limit close to 0.10 with my AHI still under 1.0 Last night I tried setting EPR to 3 and today OSCAR shows me a flow limit of 0.25 with an AHI of 2.42 with the addition of some Central Anepas! I understand that both are acceptable but am looking to achieve the best possible results with my treatment! I just set the machine to EPR of 2 and will see if the results are better tonight! Your thoughts please! Thank you!

[desaturator]

I'm not convinced that it's good to rely on a single night's results. My AHI and other measurements change every night, even if I don't touch anything. I would expect that you'd need at least a few days with a particular setting to judge how effective it is, if not longer.

BW, DS

[Sleeprider]

EPR is like bilevel pressure support where separate pressure is delivered in inspiration (IPAP) and exhale (EPAP). This increases the ventilation rate, usually visible in the tidal volume and minute vent results, sufficiently to reduce carbon dioxide from the bloodstream. Carbon dioxide is a principle driver of respiration, and higher carbon dioxide will usually increase the respiratory rate and volume, while lower carbon dioxide suppresses respiratory drive. You apparently tolerate EPR at 2, but experience some central apnea, at EPR 3. This is simply a pause in breathing for 10 seconds or longer, and has no significant effect on your health when events are short and infrequent. This is significantly different from obstructive sleep apnea which creates high pressures in the chest as respiratory effort increases to overcome obstruction.

It is likely that after some time of using EPR 2, your body will "recalibrate" its need for CO2 and the carbonic acidity that drives respiration. This adaptation may make you more tolerant to higher EPR or pressure support. I think it's best to focus on what feels best and delivers the best sleep. Some people tolerate a certain level of flow limitation without a great deal of respiratory effort related arousal (RERA), while others do not. One of the first lessons of CPAP therapy is that what works for one individual may not be the best for another. You have done the right thing by trying out some setting alternatives and choosing what works best for you. If there is a problem with using Oscar, it can cause some people to chase numbers, rather than restful comfortable therapy.

[staceyburke]

Flow limits are not included in the AHI. They are apnea but not as bad - in my signature you can find out how they categorize apnea. Flow limits cause 2 problems with people. first it is what the ResMed uses to start raising pressure. If you look at the Flow limit and compare them to your pressure graph you will see the pressure rise when the flow limit happens. Because of this some people do not get as much deep sleep when the pressure rises. It can also lead to mask leaks as the pressure gets higher.

So your answer is how you feel. As you change the EPR ask yourself do I feel better at this level. If you are not having problems with the flow limits described in the above paragraph then they are not effecting you. Many people find that flow limits stop them from getting a good nights sleep.

[Joe Bezz]

I will leave EPR at 3 and review the data over the next few days! Thank you all for your help! Sleep well everyone!

[SarcasticDave94]

Look for trends when you've left settings as is for 3 days. Just my opinion but by day 3 you'll get a fair idea what you can expect.